Resection of a Cardiac Sarcoma

This case involved a 74-year-old woman who complained of dyspnea on exertion for the past three weeks. She also reported dysphagia for solids without experiencing weight loss. The patient had a history of hypertension and dyslipidemia, and a previous occurrence of deep vein thrombosis. During a cardiac evaluation, a transthoracic ultrasound revealed a large mass in the left atrium. The patient was then referred to the surgeons’ hospital for further diagnostic investigations. A transesophageal echocardiography confirmed the presence of a 5 x 3 cm mass originating from the posterolateral wall of the left atrium, partially obstructing the mitral orifice and the left superior pulmonary vein. A cardiac magnetic resonance imaging (MRI) scan completed the imaging of the cardiac mass obstruction. A positron emission tomography-computed tomography (PET-CT) revealed expansive brain lesions in both hemispheres and the left cerebellum. Coronary angiography did not reveal any stenosis. During these diagnostic tests, the patient presented with syncope related to an episode of atrial fibrillation. The inability to perform a biopsy and the progression of symptoms caused by the obstruction of the mass indicated the need for surgical excision.

The Surgical Excision

The procedure was performed via median sternotomy with aortic and bicaval cannulation. After aortic cross-clamping and antegrade del Nido cardioplegia, the left atrium was opened through the Sondegaard groove. The atriotomy was then extended toward the atrial roof and the left pulmonary arteries by mobilizing the superior vena cava. The mass was then gently cleaved from the left atrial wall where possible. Infiltration of the posterior wall required resection and replacement with a bovine pericardial patch.

Conclusion

The weaning from the cardiopulmonary bypass was uneventful, and the operation was completed in the usual manner. The patient presented a transient atrial fibrillation episode during the postoperative period. The histologic evaluation revealed a poorly differentiated grade 3 sarcoma (Fédération Nationale des Centres de Lutte Contre le Cancer) (1) with a poor prognosis considering the cerebral metastatic disseminations (2).

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References

1. Neuville, A., Chibon, F., and Coindre, J. M. (2014). Grading of soft tissue sarcomas: from histological to molecular assessment. Pathology 46, 113–120. doi: 10.1097/PAT.0000000000000048
2. Bangolo A, Fwelo P, Iyer KM, Klinger S, Tavares L, Dey S, Chacko AA, Hein M, Gudena S, Lawal G, Sivasubramanian BP, Rimba Z, Hirpara K, Merajunnissa M, Veliginti S, Arana G, Sathyarajan DT, Singh S, Shetty T, Bhardwaj K, Hashemy S, Duran RL, Kim SH, Hipolito CM, Yoon K, Patel V, Alshimari A, Inban P, Yasmeen S, Devanaboyina K, Kumar G, Preet S, Akhtar M, Abdi A, Nalajala N, Rizvi SFM, Gupta B, Weissman S. Primary Cardiac Sarcoma: Clinical Characteristics and Prognostic Factors over the Past 2 Decades. Diseases. 2023 May 14;11(2):74. doi: 10.3390/diseases11020074. PMID: 37218887; PMCID: PMC10204403.

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